Aminophylline Dosage In Asthma Exacerbations in Children: A Systematic Review

BACKGROUND: Adequate asthma treatment of childhood exacerbations with IV aminophylline depends on appropriate dosage. Recommendations to aim for a target therapeutic range may be inappropriate as serum concentrations correlate poorly with clinical improvement. This review aims to evaluate the evidence for the optimum dosage strategy of intravenous aminophylline in children suffering an exacerbation of asthma. METHODS: A systematic review comparing dosage regimens of intravenous aminophylline in children suffering an exacerbation of asthma. Primary outcomes were time until resolution of symptoms, mortality and need for mechanical ventilation. Secondary outcomes were date until discharge criteria are met, actual discharge and adverse effects. DATA SOURCES: CENTRAL, CINAHL, MEDLINE and Web of Science. Search performed in March 2016 ELIGIBILITY CRITERIA: Studies using intravenous aminophylline in children with an acute exacerbation of asthma which reported the dosage and clinical outcomes. FINDINGS: 14 RCTs were included. There is a poor relationship between the dosage administered to children and symptom resolution, length of stay or need for mechanical ventilation. This study is limited due to its use of indirect evidence. CONCLUSION: The currently recommended dosage regimens may not represent the optimum safety and efficacy of intravenous aminophylline. There is a need to develop the evidence base correlating dosage with patient centered clinical outcomes, to improve prescribing practices.